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Appropriateness Criteria

Reference Study Type Patients/Events Study Objective(Purpose of Study) Study Results Study Quality
6. American College of Radiology. ACR Committee on Drugs and Contrast Media. Manual on Contrast Media.  Available at: https://www.acr.org/Clinical-Resources/Clinical-Tools-and-Reference/Contrast-Manual. Review/Other-Dx N/A Guidance document to assist radiologists in recognizing and managing the small but real risks inherent in the use of contrast media. No abstract available. 4
10. Paulis LV, Lewin AA, Weinstein SP, et al. ACR Appropriateness Criteria® Supplemental Breast Cancer Screening Based on Breast Density: 2024 Update. J Am Coll Radiol 2025;22:S405-S23. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for supplemental breast cancer screening based on breast density. No results stated in abstract. 4
11. diFlorio-Alexander RM, Slanetz PJ, et al. ACR Appropriateness Criteria® Breast Imaging of Pregnant and Lactating Women. J Am Coll Radiol. 2018 Nov;15(11S):S1546-1440(18)31155-4. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for breast imaging of pregnant and lactating women. No results stated in abstract. 4
12. Abramson L, Massaro L, Alberty-Oller JJ, Melsaether A. Breast Imaging During Pregnancy and Lactation. J Breast Imaging. 1(4):342-351, 2019 Dec 05. Review/Other-Dx N/A To describe when and how to screen, how to work up palpable masses, and evaluate bloody nipple discharge. No results stated in abstract. 4
13. Qian Y, Chang C, Zhang H. Ultrasound Imaging Characteristics of Breast Lesions Diagnosed During Pregnancy and Lactation. Breastfeed Med. 2019 Dec;14(10):712-717. Review/Other-Dx 195 patients To review the ultrasound (US) imaging characteristics of breast lesions during pregnancy/lactation and to demonstrate ultrasonography as an excellent imaging modality in this patient population. The breast lesions of patients during pregnancy/lactation were compared with those during nonpregnancy/lactation. Patients with breast cancer or fibroadenomas during pregnancy/lactation were younger than those during nonpregnancy/lactation. The average lesion diameter was significantly higher among pregnant/lactating patients compared with controls of childbearing age for fibroadenomas, but not for malignant lesions. The fibroadenomas and mastitis/abscesses during pregnancy/lactation usually have higher BI-RADS categories than those during nonpregnancy/lactation. 4
14. Zafrakas M, Papasozomenou P, Gerede A, Mikos T, Athanasiadis A, Grimbizis G. Screening and Diagnostic Mammography During Pregnancy and Lactation: A Systematic Review of the Literature. Cureus. 2024 Aug;16(8):e66465. Review/Other-Dx 20 studies To systematically review the existing evidence regarding the overall use of mammography during pregnancy and lactation. All 20 studies were retrospective; 14 studies included women with pregnancy-associated breast cancer, five studies included women with breast symptoms during pregnancy and/or lactation and one study included young breast cancer patients under age 40. Overall, 420 diagnostic and one incidental screening mammography examinations were performed during pregnancy and/or lactation with a 78.6% cumulative detection rate of breast cancer. The role of mammography was confounded by the use of breast ultrasound in most studies. In conclusion, the use of mammography during pregnancy and lactation is based on empirical data from retrospective studies, not directly addressing this issue. 4
15. Webb JA, Thomsen HS, Morcos SK, Members of Contrast Media Safety Committee of European Society of Urogenital Radiology (ESUR). The use of iodinated and gadolinium contrast media during pregnancy and lactation. Eur Radiol. 15(6):1234-40, 2005 Jun. Review/Other-Dx N/A 4
16. Tran E, Ray K. Meta-Analysis of Supplemental Breast Cancer Screening Modalities in Women with Dense Breasts and Negative Mammography. Radiol Imaging Cancer. 2023 May;5(3):e239012. Meta-analysis 22 studies Supplemental screening techniques that partially or completely overcome the problem of dense breast tissue, including DBT, HHUS, ABUS, and breast MRI, have been shown to detect mammographically occult breast cancers. No results stated in abstract. Good
17. Warner E, Hill K, Causer P, et al. Prospective study of breast cancer incidence in women with a BRCA1 or BRCA2 mutation under surveillance with and without magnetic resonance imaging. J Clin Oncol. 2011 May 01;29(13):1664-9. Observational-Dx 1,275 women If MRI screening reduces mortality in women with a BRCA1 or BRCA2 mutation, it is expected that the incidence of advanced-stage breast cancers should be reduced in women undergoing MRI screening compared with those undergoing conventional screening. There were 41 cases of breast cancer in the MRI-screened cohort (9.2%) and 76 cases in the comparison group (9.2%). The cumulative incidence of DCIS or stage I breast cancer at 6 years was 13.8% (95% CI, 9.1% to 18.5%) in the MRI-screened cohort and 7.2% (95% CI, 4.5% to 9.9%) in the comparison group (P = .01). The cumulative incidence of stages II to IV breast cancers was 1.9% (95% CI, 0.2% to 3.7%) in the MRI-screened cohort and 6.6% (95% CI, 3.8% to 9.3%) in the comparison group (P = .02). The adjusted hazard ratio for the development of stages II to IV breast cancer associated with MRI screening was 0.30 (95% CI, 0.12 to 0.72; P = .008). 4
18. Kuhl CK, Strobel K, Bieling H, Leutner C, Schild HH, Schrading S. Supplemental Breast MR Imaging Screening of Women with Average Risk of Breast Cancer. Radiology. 283(2):361-370, 2017 May. Observational-Dx 2120 women To investigate the utility and accuracy of breast magnetic resonance (MR) imaging as a supplemental screening tool in women at average risk for breast cancer and to investigate the types of cancer detected with MR imaging screening. A total of 2120 women were recruited and underwent 3861 screening MR imaging studies, covering an observation period of 7007 women-years. Breast MR imaging depicted 60 additional breast cancers (ductal carcinoma in situ, n = 20; invasive carcinoma, n = 40) for an overall supplemental cancer detection rate of 15.5 per 1000 cases (95% confidence interval [CI]: 11.9, 20.0). Forty-eight additional cancers were detected with MR imaging at initial screening (supplemental cancer detection rate, 22.6 per 1000 cases). During the 1741 subsequent screening rounds, 12 of 13 incident cancers were found with MR imaging alone (supplemental cancer detection rate, 6.9 per 1000 cases). One cancer was diagnosed with all three methods (mammography, US, and MR imaging), and none were diagnosed with mammography only or US only. Cancers diagnosed with MR imaging were small (median, 8 mm), node negative in 93.4% of cases, and dedifferentiated (high-grade cancer) in 41.7% of cases at prevalence screening and 46.0% of cases at incidence screening. No interval cancers were observed. MR imaging screening offered high specificity (97.1%; 95% CI: 96.5, 97.6) and high PPV (35.7%; 95% CI: 28.9, 43.1). 1
19. Kuhl CK. Abbreviated breast MRI for screening women with dense breast: the EA1141 trial. Br J Radiol. 2018 Oct;91(1090):20170441. Review/Other-Dx N/A To review the current situation and presents the EA1141 trial designed to investigate the utility of abbreviated breast MRI for screening average-risk females with dense breast tissue. No results in abstract. 4
20. Glechner A, Wagner G, Mitus JW, et al. Mammography in combination with breast ultrasonography versus mammography for breast cancer screening in women at average risk. Cochrane Database Syst Rev. 2023 Mar 31;3(3):CD009632. Review/Other-Dx 8 studies (209,207 women) To assess the comparative effectiveness and safety of mammography in combination with breast ultrasonography versus mammography alone for breast cancer screening for women at average risk of breast cancer. We included eight studies: one RCT, two prospective cohort studies, and five retrospective cohort studies, enrolling 209,207 women with a follow-up duration from one to three years. The proportion of women with dense breasts ranged from 48% to 100%. Five studies used digital mammography; one study used breast tomosynthesis; and two studies used automated breast ultrasonography (ABUS) in addition to mammography screening. One study used digital mammography alone or in combination with breast tomosynthesis and ABUS or handheld ultrasonography. Six of the eight studies evaluated the rate of cancer cases detected after one screening round, whilst two studies screened women once, twice, or more. None of the studies assessed whether mammography screening in combination with ultrasonography led to lower mortality from breast cancer or all-cause mortality. High certainty evidence from one trial showed that screening with a combination of mammography and ultrasonography detects more breast cancer than mammography alone. The J-START (Japan Strategic Anti-cancer Randomised Trial), enrolling 72,717 asymptomatic women, had a low risk of bias and found that two additional breast cancers per 1000 women were detected over two years with one additional ultrasonography than with mammography alone (5 versus 3 per 1000; RR 1.54, 95% CI 1.22 to 1.94). Low certainty evidence showed that the percentage of invasive tumours was similar, with no statistically significant difference between the two groups (69.6% (128 of 184) versus 73.5% (86 of 117); RR 0.95, 95% CI 0.82 to 1.09). However, positive lymph node status was detected less frequently in women with invasive cancer who underwent mammography screening in combination with ultrasonography than in women who underwent mammography alone (18% (23 of 128) versus 34% (29 of 86); RR 0.53, 95% CI 0.33 to 0.86; moderate certainty evidence). Further, interval carcinomas occurred less frequently in the group screened by mammography and ultrasonography compared with mammography alone (5 versus 10 in 10,000 women; RR 0.50, 95% CI 0.29 to 0.89; 72,717 participants; high certainty evidence). False-negative results were less common when ultrasonography was used in addition to mammography than with mammography alone: 9% (18 of 202) versus 23% (35 of 152; RR 0.39, 95% CI 0.23 to 0.66; moderate certainty evidence). However, the number of false-positive results and necessary biopsies were higher in the group with additional ultrasonography screening. Amongst 1000 women who do not have cancer, 37 more received a false-positive result when they participated in screening with a combination of mammography and ultrasonography than with mammography alone (RR 1.43, 95% CI 1.37 to 1.50; high certainty evidence). Compared to mammography alone, for every 1000 women participating in screening with a combination of mammography and ultrasonography, 27 more women will have a biopsy (RR 2.49, 95% CI 2.28 to 2.72; high certainty evidence). Results from cohort studies with methodological limitations confirmed these findings. A secondary analysis of the J-START provided results from 19,213 women with dense and non-dense breasts. In women with dense breasts, the combination of mammography and ultrasonography detected three more cancer cases (0 fewer to 7 more) per 1000 women screened than mammography alone (RR 1.65, 95% CI 1.0 to 2.72; 11,390 participants; high certainty evidence). A meta-analysis of three cohort studies with data from 50,327 women with dense breasts supported this finding, showing that mammography and ultrasonography combined led to statistically significantly more diagnosed cancer cases compared to mammography alone (RR 1.78, 95% CI 1.23 to 2.56; 50,327 participants; moderate certainty evidence). For women with non-dense breasts, the secondary analysis of the J-START study demonstrated that more cancer cases were detected when adding ultrasound to mammography screening compared to mammography alone (RR 1.93, 95% CI 1.01 to 3.68; 7823 participants; moderate certainty evidence), whilst two cohort studies with data from 40,636 women found no statistically significant difference between the two screening methods (RR 1.13, 95% CI 0.85 to 1.49; low certainty evidence). 4
21. Hussein H, Abbas E, Keshavarzi S, et al. Supplemental Breast Cancer Screening in Women with Dense Breasts and Negative Mammography: A Systematic Review and Meta-Analysis. Radiology. 2023 Mar;306(3):e221785. Meta-analysis 22 studies (261,233 total screened patients) To conduct systematic review and meta-analysis comparing clinical outcomes of the most common available supplemental screening modalities in women at average risk or intermediate risk for breast cancer in patients with dense breasts and mammography with negative findings. Of 132 166 screened patients with dense breast and mammography negative for cancer who met inclusion criteria, a total of 541 cancers missed at mammography were detected with these supplemental modalities. Metaregression models showed that MRI was superior to other supplemental modalities in CDR (incremental CDR, 1.52 per 1000 screenings; 95% CI: 0.74, 2.33; P < .001), including invasive CDR (invasive CDR, 1.31 per 1000 screenings; 95% CI: 0.57, 2.06; P < .001), and in situ disease (rate of ductal carcinoma in situ, 1.91 per 1000 screenings; 95% CI: 0.10, 3.72; P < .04). No differences in PPV1 and PPV3 were identified. The limited number of studies prevented assessment of interval cancer metrics. Excluding MRI, no statistically significant difference in any metrics were identified among the remaining imaging modalities. Good
22. Bakker MF, de Lange SV, Pijnappel RM, et al. Supplemental MRI Screening for Women with Extremely Dense Breast Tissue. N Engl J Med. 2019 Nov 28;381(22):2091-2102. Meta-analysis 29 studies To review the published literature on the use of ultrasound in addition to mammography in screening women with dense breast tissue.To summarise in quantitative terms the likely benefit in terms of increased breast cancer detection, and the effect on the increased diagnostic activity, specifically in terms of recall rates for assessment. Twenty-nine studies satisfied our inclusion criteria. The proportion of total cancers detected only by ultrasound was 0.29 (95% CI: 0.27-0.31), consistent with an approximately 40% increase in the detection of cancers compared to mammography. In the studied populations, this translated into an additional 3.8 (95% CI: 3.4-4.2) screen-detected cases per 1000 mammography-negative women. About 13% (32/248) of cancers were in situ from 17 studies with information on this subgroup. Ultrasound approximately doubled the referral for assessment in three studies with these data. Good
23. Veenhuizen SGA, de Lange SV, Bakker MF, et al. Supplemental Breast MRI for Women with Extremely Dense Breasts: Results of the Second Screening Round of the DENSE Trial. Radiology. 299(2):278-286, 2021 05. Observational-Dx Intervention arm (invitation to undergo supplemental MRI screening, n = 8061) and control arm (biennial mammographic screening only, n = 32,312) To investigate screening performance indicators of the second round (incidence round) of the DENSE trial. A total of 3436 women (median age, 56 years; interquartile range, 48-64 years) underwent a second MRI screening. The CDR was 5.8 per 1000 screening examinations (95% CI: 3.8, 9.0) compared with 16.5 per 1000 screening examinations (95% CI: 13.3, 20.5) in the first round. The FPR was 26.3 per 1000 screening examinations (95% CI: 21.5, 32.3) in the second round versus 79.8 per 1000 screening examinations (95% CI: 72.4, 87.9) in the first round. The positive predictive value for recall was 18% (20 of 110 participants recalled; 95% CI: 12.1, 26.4), and the positive predictive value for biopsy was 24% (20 of 84 participants who underwent biopsy; 95% CI: 16.0, 33.9), both comparable to that of the first round. All tumors in the second round were stage 0-I and node negative. 3
24. Mann RM, Athanasiou A, Baltzer PAT, et al. Breast cancer screening in women with extremely dense breasts recommendations of the European Society of Breast Imaging (EUSOBI). Eur Radiol. 2022 Jun;32(6):4036-4045. Review/Other-Dx N/A To report on contrast-enhanced breast MRI as a screening method in women with extremely dense breasts. No results stated in abstract. 4
25. Kuhl CK, Schrading S, Strobel K, Schild HH, Hilgers RD, Bieling HB. Abbreviated breast magnetic resonance imaging (MRI): first postcontrast subtracted images and maximum-intensity projection-a novel approach to breast cancer screening with MRI. J Clin Oncol. 2014 Aug 01;32(22):2304-10. Observational-Dx 443 women To investigate whether an abbreviated protocol (AP), consisting of only one pre- and one postcontrast acquisition and their derived images (first postcontrast subtracted [FAST] and maximum-intensity projection [MIP] images), was suitable for breast magnetic resonance imaging (MRI) screening. MRI acquisition time for FDP was 17 minutes, versus 3 minutes for the AP. Average time to read the single MIP and complete AP was 2.8 and 28 seconds, respectively. Eleven breast cancers (four ductal carcinomas in situ and seven invasive cancers; all T1N0 intermediate or high grade) were diagnosed, for an additional cancer yield of 18.2 per 1,000. MIP readings were positive in 10 (90.9%) of 11 cancers and allowed establishment of the absence of breast cancer, with a negative predictive value (NPV) of 99.8% (418 of 419). Interpretation of the complete AP, as with the FDP, allowed diagnosis of all cancers (11 [100%] of 11). Specificity and positive predictive value (PPV) of AP versus FDP were equivalent (94.3% v 93.9% and 24.4% v 23.4%, respectively). 2
26. Comstock CE, Gatsonis C, Newstead GM, et al. Comparison of Abbreviated Breast MRI vs Digital Breast Tomosynthesis for Breast Cancer Detection Among Women With Dense Breasts Undergoing Screening. JAMA. 323(8):746-756, 2020 02 25. Experimental-Dx 1444 women To compare the screening performance of abbreviated breast magnetic resonance imaging (MRI) and digital breast tomosynthesis (DBT) in women with dense breasts. Among 1516 enrolled women, 1444 (median age, 54 [range, 40-75] years) completed both examinations and were included in the analysis. The reference standard was positive for invasive cancer with or without DCIS in 17 women and for DCIS alone in another 6. No interval cancers were observed during follow-up. Abbreviated breast MRI detected all 17 women with invasive cancer and 5 of 6 women with DCIS. Digital breast tomosynthesis detected 7 of 17 women with invasive cancer and 2 of 6 women with DCIS. The invasive cancer detection rate was 11.8 (95% CI, 7.4-18.8) per 1000 women for abbreviated breast MRI vs 4.8 (95% CI, 2.4-10.0) per 1000 women for DBT, a difference of 7 (95% CI, 2.2-11.6) per 1000 women (exact McNemar P?=?.002). For detection of invasive cancer and DCIS, sensitivity was 95.7% (95% CI, 79.0%-99.2%) with abbreviated breast MRI vs 39.1% (95% CI, 22.2%-59.2%) with DBT (P?=?.001) and specificity was 86.7% (95% CI, 84.8%-88.4%) vs 97.4% (95% CI, 96.5%-98.1%), respectively (P?<?.001). The additional imaging recommendation rate was 7.5% (95% CI, 6.2%-9.0%) with abbreviated breast MRI vs 10.1% (95% CI, 8.7%-11.8%) with DBT (P?=?.02) and the PPV was 19.6% (95% CI, 13.2%-28.2%) vs 31.0% (95% CI, 17.0%-49.7%), respectively (P?=?.15). 1
27. Baek SJ, Ko KH, Jung HK, Park AY, Koh J. Comparison of Abbreviated MRI with Mammography and Ultrasound in Women with a Personal History of Breast Cancer. Acad Radiol. 2022 Jan;29 Suppl 1():S1076-6332(21)00261-0. Review/Other-Dx 710 patients To compare abbreviated MRI with mammography and US for screening in women with a personal history of breast cancer. In addition, the first and subsequent rounds of abbreviated MRI were compared. There were 15 (2.1%) cases of second breast cancer. Thirty-nine of the 939 abbreviated MRI scans were diagnosed as positive; of them, 11 were diagnosed as breast cancer, with a PPV2 of 28.2% (US, 19.0%; mammography, 28.6%). The AUC, sensitivity, and cancer detection rate (per 1000) were the highest for abbreviated MRI (0.829, 68.8% and 11.7) (US: 0.616, 25.0%, and 4.3; mammography: 0.560, 12.5%, and 2.1, respectively). Two hundred women underwent multiple rounds of abbreviated MRI. AUC, PPV2, and the cancer detection rates were higher during the subsequent rounds (0.987, 45.5, and 21.8) than during the first round (0.605, 11.1, and 5). 4
28. Kuhl CK. Abbreviated Breast MRI: State of the Art. Radiology. 2024 Mar;310(3):e221822. Review/Other-Dx N/A To define the three subtypes of abbreviated MRI, highlighting the differences between the protocols and their clinical implications and summarizing the respective evidence on diagnostic accuracy and clinical utility. No results stated in abstract. 4
29. Kieturakis AJ, Wahab RA, Vijapura C, Mahoney MC. Current Recommendations for Breast Imaging of the Pregnant and Lactating Patient. AJR Am J Roentgenol. 2021 Jun;216(6):1462-1475. Review/Other-Dx N/A To review the physiologic changes of the breast during pregnancy and lactation; the safety and utility of various imaging modalities; upto-date consensus on screening guidelines; recommendations for diagnostic evaluation of breast pain, palpable abnormalities, and nipple discharge; and recommendations regarding advanced modalities such as breast MRI. No results stated in abstract. 4
30. Sorin V, Yagil Y, Yosepovich A, et al. Contrast-Enhanced Spectral Mammography in Women With Intermediate Breast Cancer Risk and Dense Breasts. AJR Am J Roentgenol. 2018 Nov;211(5):W267-W274. Observational-Dx 611 women To compare the diagnostic performance of contrast-enhanced spectral mammography (CESM) and ultrasound with that of standard digital mammography for breast cancer screening of women at intermediate risk who have dense breasts. Among the 611 women included, 48.3% (295/611) had family or personal history of breast cancer, the BI-RADS breast density score was C or D in 93.1% (569/611). The mean follow-up period was 20 months. Mammography depicted 11 of 21 malignancies, sensitivity of 52.4%, specificity of 90.5% (534/590), positive predictive value of 16.4% (11/67), and negative predictive value of 98.2% (534/544). CESM depicted 19 of 21 malignancies, sensitivity of 90.5%, specificity of 76.1% (449/590), positive predictive value of 11.9% (19/160), and negative predictive value of 99.6% (449/451). Differences in sensitivity (p = 0.008) and specificity (p < 0.001) were statistically significant. Adjunct ultrasound revealed 73 additional suspicious findings; all were false-positive. In 39 women MRI was needed to assess screening abnormalities; two MRI-guided biopsies were performed and yielded one cancer. The incremental cancer detection rate of CESM was 13.1/1000 women (95% CI, 6.1-20.1). Of eight cancers seen only with CESM, seven were invasive (mean size, 9 mm; two of four cancers lymph-node positive). 2
31. Gilbert FJ, Payne NR, Allajbeu I, et al. Comparison of supplemental breast cancer imaging techniques-interim results from the BRAID randomised controlled trial. Lancet. 405(10493):1935-1944, 2025 May 31.Lancet. 405(10493):1935-1944, 2025 May 31. Experimental-Dx 9361 eligible women To compare abbreviated MRI, automated whole breast ultrasound (ABUS), and contrast-enhanced mammography versus standard of care in women with dense breasts and a negative mammogram. We report on interim results from the first round of supplemental imaging. From October 18, 2019, to March 30, 2024, 9361 eligible women were recruited and randomly assigned (2318 to abbreviated MRI, 2240 to ABUS, 2235 to contrast-enhanced mammography, and 2568 to standard of care). Of those, 6305 completed supplementary imaging (2130 in the abbreviated MRI, 2141 in the ABUS, and 2035 in the contrast-enhanced mammography) and were included in the outcome analysis. The cancer detection rate was 17·4 (95% CI 12·2-23·9, n=37) per 1000 examinations for abbreviated MRI, 4·2 (1·9-8·0, n=9) per 1000 examinations for ABUS, and 19·2 (13·7-26·1, n=39) per 1000 examinations for contrast-enhanced mammography, of which 15·0 (10·3-21·1, n=32) per 1000 women for abbreviated MRI, 4·2 (1·9-8·0, n=9) per 1000 examinations for ABUS, and 15·7 (10·8-22·1, n=32) per 1000 examinations for contrast-enhanced mammography were invasive cancers. The detection rates for abbreviated MRI were significantly higher than for ABUS (p=0·047) and non-significantly higher than for contrast-enhanced mammography (p=0·62). There was one case of extravasation in the abbreviated MRI arm (0·5 events per 1000 examinations), no adverse events in the ABUS arm, and 24 iodinated contrast reactions (17 minor [8·4 events per 1000 examinations], six moderate [2·9 events per 1000 examinations], and one severe [0·5 events per 1000 examinations]) and three extravasations (1·5 extravasations per 1000 examinations) in the contrast-enhanced mammography arm. 3
33. Kubik-Huch RA, Gottstein-Aalame NM, Frenzel T, et al. Gadopentetate dimeglumine excretion into human breast milk during lactation. Radiology. 216(2):555-8, 2000 Aug. Experimental-Dx 20 lactating women To analyze the amount of gadopentetate dimeglumine excreted into human breast milk following intravenous injection of a clinical dose. The cumulative amount of gadolinium excreted in human breast milk during 24 hours was 0.57 micromol +/- 0.71 (SD; range, 0.05-3.0 micromol). The excreted dose was thus less than 0.04% of the administered intravenous dose (range, 0.001%-0.04%; mean, 0.009% +/- 0.010) for all cases. 3
34. Oh SW, Lim HS, Moon SM, et al. MR imaging characteristics of breast cancer diagnosed during lactation. Br J Radiol. 2017 Oct;90(1078):20170203. Review/Other-Dx 9 patients To describe the MR imaging characteristics of breast cancer diagnosed during lactation and evaluate the usefulness of MR imaging. Although the breasts showed marked (n = 7) or moderate (n = 2) background parenchymal enhancement, MR imaging depicted breast cancer in all patients. All nine tumours were visible as masses. The most common shape and margin of the masses were an irregular mass (n = 5) with an irregular margin (n = 9). Contrast enhancement was heterogeneous or rim enhancement. The predominant kinetic pattern was rapid increase (n = 9) in the initial phase and washout (n = 5) in the delayed phase. Additional sites of cancer other than the index lesion were detected with MR imaging in three patients (33.3%). MR imaging demonstrated partial response in five of six patients who were evaluated for response to chemotherapy. 4
35. Monticciolo DL, Newell MS, Moy L, Lee CS, Destounis SV. Breast Cancer Screening for Women at Higher-Than-Average Risk: Updated Recommendations From the ACR. J Am Coll Radiol. 2023 Sep;20(9):S1546-1440(23)00334-4. Review/Other-Dx N/A To provide guidance on imaging women at higher-than-average risk with new data on digital breast tomosynthesis (DBT), contrast-enhanced mammography (CEM), and contrast-enhanced breast MRI (hereafter MRI) and reassessment on breast ultrasound and molecular breast imaging (MBI). No results in abstract. 4
36. Portnow LH, Snider LC, Bolivar KE, et al. Breast Cancer Screening in High-risk Women During Pregnancy and Lactation. Journal of Breast Imaging. 5(5):508-519, 2023 09 22.J Breast Imaging. 5(5):508-519, 2023 09 22. Review/Other-Dx N/A To discusses the current state of evidence- and expert-based guidelines and data for breast imaging screening of high-risk pregnant and/or lactating women, and the clinical and imaging presentations of breast cancer for these women. No results stated in abstract. 4
40. Weinstein SP, Korhonen K, Cirelli C, et al. Abbreviated Breast Magnetic Resonance Imaging for Supplemental Screening of Women With Dense Breasts and Average Risk. J Clin Oncol. 2020 Nov 20;38(33):3874-3882. Observational-Dx 475 asymptomatic women with dense breasts To report the prevalent cancer detection rate (CDR) from the first clinical implementation of abbreviated breast magnetic resonance imaging (AB-MR) as a supplemental screening test in women with dense breasts. Out of 511 prevalent rounds of AB-MR examinations, 36 women were excluded. The remaining 475 asymptomatic women with dense breasts had negative/benign DBT examinations before the AB-MR. There were 420 of 475 (88.4%) benign/negative examinations, 13 of 475 (2.7%) follow-up recommendations, and 42 biopsy recommendations. Thirty-nine biopsies were completed, resulting in 12/39 (30.8%) malignancies in 12 women: seven invasive carcinomas and five ductal carcinoma in situ. One additional patient was diagnosed with invasive ductal carcinoma at the time of 6-month follow-up. The CDR was 27.4 per 1,000 (13 of 475; 95% CI, 16.1 to 46.3). The size of invasive carcinomas ranged from 0.6-1.0 cm (mean, 0.5 cm). Of the seven women who underwent surgical evaluation of the axilla, zero of seven patients had positive nodes. There were no interval cancers at 1-year follow-up. 2
41. Johansson ALV, Weibull CE, Fredriksson I, Lambe M. Diagnostic pathways and management in women with pregnancy-associated breast cancer (PABC): no evidence of treatment delays following a first healthcare contact. Breast Cancer Res Treat. 2019 Apr;174(2):489-503. Review/Other-Dx 546 women To compare symptoms, diagnostics, treatments, and waiting times from first symptoms to treatment initiation in women diagnosed with PABC and non-PABC. Initial symptoms in women with PABC and non-PABC were similar. Women with PABC more often underwent biopsy and ultrasound than mammography at initial examination. Compared to non-PABC, rates of mastectomy and axillary clearance were higher in women with PABC, while endocrine treatment was less common. The time from symptoms to first healthcare contact was non-significantly longer in women diagnosed during or within 6 months of pregnancy. Waiting times from contact with healthcare to diagnosis and treatment were shorter or similar in women with PABC compared to women with non-PABC. 4
42. Taron J, Fleischer S, Preibsch H, Nikolaou K, Gruber I, Bahrs S. Background parenchymal enhancement in pregnancy-associated breast cancer: a hindrance to diagnosis?. Eur Radiol. 2019 Mar;29(3):1187-1193. Review/Other-Dx 19 patients To investigate the detectability of pregnancy-associated breast cancer (PABC) in lactating glandular tissue on magnetic resonance imaging (MRI) by using pre- and post-contrast acquisitions and their derived postprocessed images and compare these results to ultrasound (US) and mammography (MG). Nineteen patients (range 27-42 years) were included. Background parenchymal enhancement (BPE) was minimal (n=1), mild (n=3), moderate (n=7) and marked (n=8) with kinetics measured plateau (n=8), continuous (n=10) and not quantifiable (n=1). Tumour kinetics presented wash-out (n=17) and plateau (n=2). Eighteen of nineteen tumours were identified on the supplemental subtraction images. All tumours were visible on US; 12/19 were visible on MG (63.2%). MRI detected additional malignant lesions in two patients. 4
43. Chung M, Hayward JH, Woodard GA, et al. US as the Primary Imaging Modality in the Evaluation of Palpable Breast Masses in Breastfeeding Women, Including Those of Advanced Maternal Age. Radiology. 2020 Nov;297(2):316-324. Observational-Dx 167 women To evaluate the diagnostic performance of targeted US as the primary imaging modality for the evaluation of palpable masses in lactating women, including those of advanced maternal age. There were 167 women (mean age, 35 years ± 5 [standard deviation]), 101 of whom (60%) were of advanced maternal age (=35 years). All women underwent targeted US, and 98 (59%) underwent mammography in addition to US. The frequency of malignancy was five of 167 (3.0%). Targeted US demonstrated a sensitivity and specificity of five of five (100%; 95% confidence interval [CI]: 48%, 100%) and 114 of 162 (70%; 95% CI: 63%, 77%), respectively. Negative predictive value, positive predictive value of an abnormal examination, and positive predictive value of biopsy were 114 of 114 (100%; 95% CI: 97%, 100%), five of 53 (9.4%; 95% CI: 3%, 21%), and five of 50 (10%; 95% CI: 3%, 22%), respectively. In the subset of 98 women who underwent mammography in addition to US, mammography depicted seven incidental suspicious findings, which lowered the specificity from 62 of 93 (67%; 95% CI: 56%, 76%) to 57 of 93 (61%; 95% CI: 51%, 71%) (P = .02). 3
44. Klein KA, Kocher M, Lourenco AP, et al. ACR Appropriateness Criteria® Palpable Breast Masses: 2022 Update. J Am Coll Radiol 2023;20:S146-S63. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for palpable breast masses. No results stated in abstract. 4
45. Mitchell KB, Johnson HM. Challenges in the Management of Breast Conditions During Lactation. Obstet Gynecol Clin North Am. 2022 Mar;49(1):S0889-8545(21)00770-1. Review/Other-Dx N/A The lactating breast can develop a wide range of conditions that require surgical management, from abscess drainage to the evaluation of nipple-areolar complex (NAC) lesions. No results stated in abstract. 4
46. Ye DM, Bai X, Xu S, et al. Association between breastfeeding, mammographic density, and breast cancer risk: a review. Int Breastfeed J. 2024 Sep 16;19(1):65. Review/Other-Dx N/A This review highlights a clear protective link between breastfeeding and reduced breast cancer risk via changes in mammographic density. No results stated in abstract. 4
47. Kim S, Tran TXM, Kim MK, et al. Associations between breastfeeding and breast cancer risk through mammographic breast density in a cohort of Korean women. International Journal of Epidemiology. 54(1), 2024 Dec 16.Int J Epidemiol. 54(1), 2024 Dec 16. Review/Other-Dx 4 ,136, 723 women To investigate the extent to which never breastfeeding is a risk factor for breast cancerand how this risk is further mediated by increased mammographic breast density. The HR of never breastfeeding on BC risk was 1.34 (95% CI, 1.32-1.37) when adjusted for only parity, body mass index and smoking status, which were selected as covariates through a directed acyclic graph and 1.21 (95% CI, 1.19-1.23) when breast density was additionally adjusted. The proportion of the association between never breastfeeding and BC risk mediated by breast density in total, pre- and post-menopausal women was 35.48%, 17.86% and 24.0%, respectively (all P < 0.001). The HR of never breastfeeding on BC risk was 1.10 (95% CI, 1.08-1.12) when adjusted for nine known breast cancer risk factors and 1.09 (95% CI, 1.07-1.12) when breast density was additionally adjusted. The proportion of the association between never breastfeeding and BC risk mediated by breast density in the total, pre- and post-menopausal women was 7.50%, 3.71% and 12.21%, respectively (all P < 0.001). 4
48. Peterson MS, Gegios AR, Elezaby MA, et al. Breast Imaging and Intervention during Pregnancy and Lactation. Radiographics. 2023 Oct;43(10):e230014. Review/Other-Dx N/A To review the normal physiologic changes of the breasts during pregnancy and lactation, discuss recommended screening and diagnostic guidelines, and describe imaging features of common benign and malignant entities. No results stated in abstract. 4
49. Pyle C, Hill M, Sharafi S, Forton C, Sohaey R. Pregnancy-associated Breast Cancer: Why Breast Imaging During Pregnancy and Lactation Matters. J Breast Imaging. 2023 Nov 30;5(6):732-743. Review/Other-Dx N/A To illustrate the spectrum of imaging appearances of pregnancy-associated breast cancer, the appropriate diagnostic imaging workup, and the unique challenges encountered in evaluation of this patient population. No results stated in abstract. 4
53. Chung HL, Bevers TB, Legha RS, et al. Nipple Discharge Imaging Evaluation with Mammography, Ultrasound, Galactography, and MRI. Acad Radiol. 2023 May;30(5):S1076-6332(22)00316-6. Review/Other-Dx 320 patients To determine the diagnostic yield of various imaging tests used to evaluate nipple discharge. Of the 320 patients, pathology or follow up confirmed 40 breast malignancies (40/320, 12.5%),14 atypical HRLs (14/320, 4.4%), 71 IDPs (71/320, 22.2%), 48 other benign pathologies (48/320,15.0%), and 147 unknown but benign cases (147/320, 45.9%). Physiologic discharge characteristics were observed in a minority of malignant cases: nonspontaneous (4/40, 10.0%); neither bloody nor clear (4/40, 10.0%); bilateral (3/40, 7.5%). Malignancy was associated with older age (p < 0.001) and bloody discharge (odds ratio 6.5, p < 0.0001). The combination of digital mammography and ultrasound had a 93% sensitivity and a 98% NPV, while contrast enhanced MRI (CE-MRI) had a 100% sensitivity and a 100% NPV for malignancy. Only three galactography examinations were performed among the malignant cohort, with minimal contribution (1 of 3) to the diagnostic evaluation. In this case, galactography findings helped determine imaging-pathology discordance, prompting a recommendation for surgical excision and subsequently a malignant diagnosis. 4
56. Bahl M, Baker JA, Greenup RA, Ghate SV. Diagnostic Value of Ultrasound in Female Patients With Nipple Discharge. AJR Am J Roentgenol. 2015;205(1):203-208. Observational-Dx 327 female patients To assess the contribution of ultrasound to the evaluation of patients with pathologic nipple discharge at a large academic institution. Over a 3-year period, 327 females (mean age, 48 years; range, 13-88 years) presented with nipple discharge. Among these patients, 273 (83%) underwent surgical excision or clinical or radiographic follow-up at least 2 years after presentation and composed the study population. Among the 273 patients, 262 (96%) underwent mammography and 246 (90%) underwent sonography. Among 252 patients who had at least one pathologic feature of nipple discharge and underwent surgical excision or at least 2 years of follow-up, a total of 20 (8%) cases of ductal carcinoma in situ (DCIS) or invasive adenocarcinoma were diagnosed. DCIS or invasive adenocarcinoma was diagnosed in eight patients with normal sonographic findings. For the detection of DCIS and invasive adenocarcinoma, the sensitivity and specificity of ultrasound were 56% (10/18) and 75% (170/228); the sensitivity and specificity of mammography were 15% (3/20) and 98% (237/242). 3
58. Sanford MF, Slanetz PJ, et al. ACR Appropriateness Criteria® Evaluation of Nipple Discharge: 2022 Update. J Am Coll Radiol. 2022 Nov;19(11S):S1546-1440(22)00654-8. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for evaluation of nipple discharge. No results stated in abstract. 4
59. Rissanen T, Reinikainen H, Apaja-Sarkkinen M. Breast sonography in localizing the cause of nipple discharge: comparison with galactography in 52 patients. J Ultrasound Med. 26(8):1031-9, 2007 Aug. Observational-Dx 52 patients To evaluate breast sonography in localizing abnormalities in the discharging duct in patients with spontaneous nipple discharge. The final diagnosis was benign in 47 cases (90%) and malignant in 5 cases (10%). Sonography visualized an echogenic intraductal tumor in 36 (69%) of 52 cases, dilated duct(s) without an intraductal tumor in 6 cases (12%), and no abnormality in 10 cases (19%). Eighty percent of papillomatous lesions, 58% of other benign lesions, and 20% of malignant lesions were sonographically positive. The abnormal duct was surgically removed after methylene blue staining in 38 cases, after sonographically guided wire localization in 11 cases, after both wire localization and methylene blue staining in 1 case, and with review of the diagnostic galactographic images in 2 cases. 3
60. Gray RJ, Pockaj BA, Karstaedt PJ. Navigating murky waters: a modern treatment algorithm for nipple discharge. Am J Surg. 2007 Dec;194(6):850-4; discussion 854-5. Review/Other-Dx 204 patients Women with nipple discharge undergo operative duct excision with few actually having carcinoma. Nipple discharge was present in 204 patients. Carcinoma was identified in 7 patients (3% of all, 9% of those undergoing biopsy). Age > or = 50 years, abnormal mammography, and abnormal sonography were the only significant predictors of carcinoma. Among patients with unilateral, spontaneous, bloody, or serous discharge with a negative mammogram, the carcinoma risk was 3%. Among patients with unilateral, spontaneous, bloody, or serous discharge with a negative mammogram and subareolar ultrasound, the carcinoma risk was 0%. 4
61. Ashfaq A, Senior D, Pockaj BA, et al. Validation study of a modern treatment algorithm for nipple discharge. Am J Surg. 208(2):222-7, 2014 Aug. Observational-Dx 192 patients To validate the proposed treatment algorithm after its implementation in our practice. A total of 192 patients, mean age 56 years, were studied. Risk of carcinoma among the entire cohort was 5%. Breast surgeon was consulted for 142 (74%) patients: 48 (34%) underwent initial subareolar excision and 94 (66%) were clinically followed. The rate of carcinoma was 17% (8/48) after initial subareolar excision, 0% (0/13) for those without imaging abnormalities, 23% (8/35) with imaging abnormalities, and 1% (1/94) with clinical follow-up. Of patients who underwent follow-up, 21% (n = 20) underwent subareolar excision because of imaging abnormality (n = 1, 1%) or persistent discharge (n = 19, 20%). Most patients had ductal carcinoma in situ (n = 5, 56%). 3
63. Woodard S, Ahuja K, Allen E. Imaging evaluation of nipple discharge: Review of literature and management considerations. [Review]. Breast Disease. 44:15581551241312602, 2025 Jan-Dec. Review/Other-Dx N/A To discuss features that differentiate physiologic from pathologic nipple discharge, provide a literature summary to guide imaging recommendations, and introduce a flow chart as an overview for step-by-step management. No results stated in abstract. 4
64. Baydoun S, Gonzalez P, Whitman GJ, Dryden M, Xi Y, Dogan B. Is Ductography Still Warranted in the 21st century?. Breast J. 2019 Jul;25(4):654-662. Review/Other-Dx 94 study patients To determine the utility of ductography in conjunction with mammography and ultrasound in patients with pathologic nipple discharge, and the incremental role of MRI after triple-modality evaluation. Among 94 study patients, benign papillomas were identified in 42 (44.7%), abscess in one (1%), duct ectasia in four (4.3%), and malignancy (invasive ductal carcinoma or ductal carcinoma in situ) or high-risk lesion (atypical ductal hyperplasia) in 10 (10.6%). Forty-six patients (49%) underwent surgical excision; 89.1% of which had presurgical planning with ductography. In 35 (37.2%) with negative imaging, resolution of nipple discharge was confirmed on median clinical and imaging follow-up of 36 months. Two patients with negative imaging were lost to follow-up. Sensitivity, specificity, PPV, and NPV for accurately demonstrating the etiology of pathologic nipple discharge were 13%, 97%, 89%, and 37% respectively for mammography; 73%, 97%, 98%, and 64% respectively for ultrasound; 76%, 72%, 84%, and 61% respectively for ductography; 86%, 70%, 85%, and 72% respectively for combined ultrasound and ductography; and 75%, 100%, 100% and 67% respectively for DCE-MRI. 4
65. Moon WK, Chang SC, Chang JM, et al. Classification of breast tumors using elastographic and B-mode features: comparison of automatic selection of representative slice and physician-selected slice of images. Ultrasound Med Biol. 2013 Jul;39(7):S0301-5629(13)00050-1. Review/Other-Dx 151 biopsy-proven lesions To use an image quantification method that automatically chooses a representative slice and then segments the tumor contour to evaluate the diagnostic features for tumor characterization. The performance of the representative slice selected using the proposed methods is compared to that of the physician-selected slice in 151 biopsy-proven lesions (89 benign and 62 malignant). The diagnostic accuracies using elastographic features are 82.1% (124/151) for the slice with the maximum CNRe value, 82.1% (124/151) for the slice with the maximum SNRe value and 82.8% (125/151) for the physician-selected slice, whereas the diagnostic accuracies using B-mode features are 80.8% (122/151) for the slice with the maximum CNRe value, 87.4% (132/151) for the slice with the maximum SNRe value and 84.1% (127/151) for the physician-selected slice. When using both the B-mode and elastographic features to characterize the tumor, the accuracy of diagnosis is 86.1% (130/151) for the slice with the maximum CNRe value, 90.1% (136/151) for the slice with the maximum SNRe value and 89.4% (135/151) for the physician-selected slice. 4
66. Gupta D, Mendelson EB, Karst I. Nipple Discharge: Current Clinical and Imaging Evaluation. AJR Am J Roentgenol. 2021 Feb;216(2):330-339. Review/Other-Dx N/A Initial evaluation of pathologic nipple discharge involves mammography and ultrasound. The problem-solving algorithm for evaluating suspicious nipple discharge is evolving. When diagnostic imaging for evaluation of pathologic nipple discharge is negative, management is based on clinical suspicion. If additional imaging is warranted, MRI is preferred because of its increased sensitivity, specificity, and patient comfort. Although central duct excision is the current standard for evaluation of malignancy in patients with pathologic nipple discharge, studies suggest that, given the high negative predictive value of MRI, surveillance may be a reasonable alternative to surgery. 4
67. Lubina N, Schedelbeck U, Roth A, et al. 3.0 Tesla breast magnetic resonance imaging in patients with nipple discharge when mammography and ultrasound fail. European Radiology. 25(5):1285-93, 2015 May.Eur Radiol. 25(5):1285-93, 2015 May. Observational-Dx 50 patients, 56 breasts To compare 3.0 Tesla breast magnetic resonance imaging (MRI) with galactography for detection of benign and malignant causes of nipple discharge in patients with negative mammography and ultrasound. Sensitivity and specificity of MRI vs. galactography for detecting pathologic findings were 95.7 % vs. 85.7 % and 69.7 % vs. 33.3 %, respectively. For the supposed concrete pathology based on MRI findings, the specificity was 67.6 % and the sensitivity 77.3 % (PPV 60.7 %, NPV 82.1 %). Eight malignant lesions were detected (14.8 %). The estimated size at breast MRI showed excellent correlation with the size at histopathology (Pearson's correlation coefficient 0.95, p < 0.0001). 2
68. Samreen N, Madsen LB, Chacko C, Heller SL. Magnetic resonance imaging in the evaluation of pathologic nipple discharge: indications and imaging findings. [Review]. British Journal of Radiology. 94(1120):20201013, 2021 Apr 01.Br J Radiol. 94(1120):20201013, 2021 Apr 01. Review/Other-Dx N/A To discuss the advantages of breast MRI as an additional diagnostic tool in patients with pathologic nipple discharge (PND) and when contentional imaging with mammogram and ultrasound are negative. No results in abstract. 4
69. Nissan N, Massasa EEM, Bauer E, et al. MRI can accurately diagnose breast cancer during lactation. European Radiology. 33(4):2935-2944, 2023 Apr.Eur Radiol. 33(4):2935-2944, 2023 Apr. Observational-Dx 198 patients To test the diagnostic performance of breast dynamic contrast-enhanced (DCE) MRI during lactation. For MIP-DCE images, the readers achieved the following means: sensitivity 93.3%, specificity 80.3%, positive-predictive-value 70.4, negative-predictive-value 96.2, and diagnostic accuracy of 84.6%, with a substantial inter-rater agreement (Kappa = 0.673, p value < 0.001). Most false-positive interpretations were attributed to either the MIP presentation, an underlying benign lesion, or an asymmetric appearance due to prior treatments. CAD's derived diagnostic accuracy was similar (p = 0.41). BPE grades were significantly increased in the healthy controls compared to the PABC cohort (p < 0.001). CNR significantly decreased by 11-13% in each of the four post-contrast images (p < 0.001). 3
70. Avdan Aslan A, Gültekin S. What is the role of breast MRI in the management of women with pathologic nipple discharge and normal conventional imaging?. Ir J Med Sci. 2023 Oct;192(5):2331-2335. Review/Other-Dx 57 women To investigate the diagnostic performance of breast MRI in revealing mammographically and sonographically occult lesions requiring excision in patients with pathologic nipple discharge. Abnormal contrast enhancement on the pathologic nipple discharge side was detected in 29 MRIs (50.8%), categorized as BI-RADS 4. Abnormal findings were solid masses in 17 cases (58.6%) and non-mass enhancement in 12 cases (41.3%). Despite normal conventional imaging results, 4 malignant lesions and 16 lesions requiring surgery were detected with MRI. The sensitivity and specificity of MRI for detecting lesions requiring surgery were 100% and 68.2%, respectively. The positive predictive value (PPV) and negative predictive value were 55.1% and 100%, respectively. 4
71. Vaz SC, Corion CLS, Goeman J, et al. Can Molecular Breast Imaging With Tc-99m Sestamibi Safely Rule Out Malignancy in Pathologic Nipple Discharge?. Clin Nucl Med. 2025 Jul 01;50(7):568-576. Review/Other-Dx 96 cases To evaluate the role of MBI in ruling out malignancy in patients with PND and negative/indeterminate CD. Of the 96 cases of PND included, 78 were benign, and 18 (20%) corresponded to breast cancer (BC). Although CD and MBI were concordant in the BIRADS classification in 81% (78/96), half of BC were detected by MBI only. BC was located directly behind the nipple in a minority of patients (11%), meaning that MBI could significantly prevent futile central ductal excision. MBI presented higher sensitivity (83% vs. 33%) and negative predictive value (96% vs. 86%) than CD alone, with similar specificity (89% vs. 92%) and positive predictive value (63% vs. 50%). The area under the curve of MBI and CD was 0.86 ( P -value<0.001 [95% CI: 0.75-0.97]) and 0.63 ( P -value=0.091 [95% CI: 0.47-0.79]), respectively. 4
72. Hruska CB, Corion C, de Geus-Oei LF, et al. SNMMI Procedure Standard/EANM Practice Guideline for Molecular Breast Imaging with Dedicated ?-Cameras. J Nucl Med Technol. 2022 Jun 03;50(2):103-110. Review/Other-Dx N/A Practice guideline for molecular breast imaging with dedicated y-cameras. No abstract available. 4
77. McDonald ES, Scheel JR, Lewin AA, et al. ACR Appropriateness Criteria® Imaging of Invasive Breast Cancer. J Am Coll Radiol 2024;21:S168-S202. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for imaging of invasive breast cancer. No results stated in abstract. 4
78. Chung WS, Tang YC, Cheung YC. Contrast-Enhanced Mammography: A Literature Review of Clinical Uses for Cancer Diagnosis and Surgical Oncology. Cancers (Basel). 2024 Dec 12;16(24):4143. Review/Other-Dx N/A To review the literature to clarify the clinical applications of CEM No results stated in abstract. 4
79. Weber BW, Mao L, Salem K, et al. Performance of Diagnostic Breast Imaging in Symptomatic Pregnant and Lactating Patients: Systematic Review and Meta-Analysis. Radiol Imaging Cancer. 2025 May;7(3):e240281. Meta-analysis 25 studies 1,681 female patients To perform a systematic review of the literature and meta-analysis to summarize the diagnostic performance of breast imaging modalities for cancer detection in pregnant and lactating patients. Twenty-five studies met the eligibility criteria and included 1681 female patients (mean age, 33 years; range, 18-49 years). For US, seven of 24 studies had complete data yielding an AUC of 0.90 (95% CI: 0.85, 0.93), a sensitivity of 81% (95% CI: 56, 94), and a specificity of 85% (95% CI: 71, 92). For mammography, three of 21 studies had complete data yielding an AUC of 0.93 (95% CI: 0.75, 0.97), a sensitivity of 72% (95% CI: 47, 88), and a specificity of 93% (95% CI: 86, 97). For MRI, two of eight studies had complete data yielding an AUC of 95% (95% CI: 59, 96), a sensitivity of 91% (95% CI: 56, 99), and a specificity of 88% (95% CI: 48, 98). Conclusion US, mammography, and breast MRI showed high diagnostic performance for detection of pregnancy-associated breast cancer in symptomatic pregnant or lactating patients. Good
80. Lehman CD, Gatsonis C, Kuhl CK, et al. MRI evaluation of the contralateral breast in women with recently diagnosed breast cancer. N Engl J Med. 2007;356(13):1295-1303. Experimental-Dx 969 women To determine whether magnetic resonance imaging (MRI) could improve on clinical breast examination and mammography in detecting contralateral breast cancer soon after the initial diagnosis of unilateral breast cancer. MRI detected clinically and mammographically occult breast cancer in the contralateral breast in 30 of 969 women who were enrolled in the study (3.1%). The sensitivity of MRI in the contralateral breast was 91%, and the specificity was 88%. The negative predictive value of MRI was 99%. A biopsy was performed on the basis of a positive MRI finding in 121 of the 969 women (12.5%), 30 of whom had specimens that were positive for cancer (24.8%); 18 of the 30 specimens were positive for invasive cancer. The mean diameter of the invasive tumors detected was 10.9 mm. The additional number of cancers detected was not influenced by breast density, menopausal status, or the histologic features of the primary tumor. 1
81. Freitas V, Li X, Amitai Y, et al. Contralateral Breast Screening with Preoperative MRI: Long-Term Outcomes for Newly Diagnosed Breast Cancer. Radiology. 304(2):297-307, 2022 08.Radiology. 304(2):297-307, 2022 08. Observational-Dx 1,199 patients total (MRI Group, n = 842 and No-MRI Group, n = 357) To assess the impact of MRI for screening the contralateral breast on long-term outcomes in patients with newly diagnosed breast cancer and to determine whether subgroups with unfavorable prognoses would benefit from MRI in terms of survival. Of 1846 patients, 1199 fulfilled the inclusion criteria. Median follow-up time was 10 years (range, 0-14 years). The 2:1 matched sample comprised 705 patients (470 in the MRI group and 235 in the no-MRI group); median ages at surgery were 59 years (range, 31-87 years) and 64 years (range, 37-92 years), respectively. MRI depicted contralateral synchronous disease more frequently (27 of 470 patients [5.7%] vs five of 235 patients [2.1%]; P = .047) and was associated with a higher OS (hazard ratio [HR], 2.51; 95% CI: 1.25, 5.06; P = .01). No differences were observed between groups in metachronous disease rate (MRI group: 21 of 470 patients [4.5%]; no-MRI group: 10 of 235 patients [4.3%]; P > .99) or CSS (HR, 1.34; 95% CI: 0.56, 3.21; P = .51). MRI benefit was greater in patients with larger tumor sizes (>2 cm) (HR, 2.58; 95% CI: 1.11, 5.99; P = .03) and histologic grade III tumors (HR, 2.94; 95% CI: 1.18, 7.32; P = .02). 3
82. Nissan N, Anaby D, Mahameed G, et al. Ultrafast DCE-MRI for discriminating pregnancy-associated breast cancer lesions from lactation related background parenchymal enhancement. European Radiology. 33(11):8122-8131, 2023 Nov.Eur Radiol. 33(11):8122-8131, 2023 Nov. Review/Other-Dx 29 patients To investigate the utility of ultrafast dynamic-contrast-enhanced (DCE) MRI in visualization and quantitative characterization of pregnancy-associated breast cancer (PABC) and its differentiation from background-parenchymal-enhancement (BPE) among lactating patients. On ultrafast MRI, breast cancer lesions enhanced earlier than BPE (p < 0.0001), enabling breast cancer visualization freed from lactation BPE. A higher CNR was found for ultrafast acquisitions vs. conventional DCE (p < 0.05). Significant differences in AUC, MS, and TTE values were found between the tumor and BPE (p < 0.05), with ROC-derived AUC of 0.86 ± 0.06, 0.82 ± 0.07, and 0.68 ± 0.08, respectively. The BPE grades of the lactating PABC patients were reduced as compared with the healthy lactating controls (p < 0.005). 4
83. Le-Petross HT, Slanetz PJ, Lewin AA, et al. ACR Appropriateness Criteria® Imaging of the Axilla. J Am Coll Radiol 2022;19:S87-S113. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for imaging of the axilla. No results stated in abstract. 4
84. Jochelson MS, Dershaw DD, Sung JS, et al. Bilateral contrast-enhanced dual-energy digital mammography: feasibility and comparison with conventional digital mammography and MR imaging in women with known breast carcinoma. Radiology. 266(3):743-51, 2013 Mar. Observational-Dx 52 women. To determine feasibility of performing bilateral dual-energy (DE) contrast agent-enhanced (CE) digital mammography and to evaluate its performance compared with conventional digital mammography and breast magnetic resonance (MR) imaging in women with known breast cancer. Feasibility was confirmed with no adverse events. Visualization of tumor enhancement was independent of timing after contrast agent injection for up to 10 minutes. MR imaging and DE CE digital mammography both depicted 50 (96%) of 52 index tumors; conventional mammography depicted 42 (81%). Lesions depicted by using DE CE digital mammography ranged from 4 to 67 mm in size (median, 17 mm). DE CE digital mammography depicted 14 (56%) of 25 additional ipsilateral cancers compared with 22 (88%) of 25 for MR imaging. There were two false-positive findings with DE CE digital mammography and 13 false-positive findings with MR imaging. There was one contralateral cancer, which was not evident with either modality. 1
85. Bozzini A, Nicosia L, Pruneri G, et al. Clinical performance of contrast-enhanced spectral mammography in pre-surgical evaluation of breast malignant lesions in dense breasts: a single center study. Breast Cancer Res Treat. 2020 Dec;184(3):723-731. Observational-Dx 160 patients To compare the efficacy of contrast-enhanced spectral mammography, with ultrasound, full field digital mammography and magnetic resonance imaging in detection and size estimation of histologically proven breast tumors. Overall, the detection rate of malignant breast lesions (in situ and invasive) was 93.8% (165/176) for contrast-enhanced spectral mammography, 94.4% (168/178) for ultrasound, 85.5 (147/172) for full field digital mammography and 97.7% (173/177) for magnetic resonance imaging. Radiological measurements were concordant with the post-surgical pathological measurements of the invasive tumor (i.e., within 5 mm) in: 64.6% for contrast-enhanced spectral mammography, 62.0% for ultrasound, 45.2% for full field digital mammography (p < 0.0001) and 69.9% for magnetic resonance imaging (p = 0.28); underestimated in: 17.4% for contrast-enhanced spectral mammography, 19.6% for ultrasound, 24.2% for full field digital mammography (p = 0.03) and 6.7% for magnetic resonance imaging (p = 0.0005); and overestimated in: 16.2% for contrast-enhanced spectral mammography, 16.6% for ultrasound, 16.6% for full field digital mammography and 22.7% for magnetic resonance imaging (p = 0.02). 2
86. Yang ML, Bhimani C, Roth R, Germaine P. Contrast enhanced mammography: focus on frequently encountered benign and malignant diagnoses. [Review]. Cancer Imaging. 23(1):10, 2023 Jan 23.Cancer Imaging. 23(1):10, 2023 Jan 23. Review/Other-Dx N/A To emphasizes expected normal findings on CEM followed by a focus on examples of the commonly encountered benign and malignant pathologies on CEM. No results stated in abstract. 4
87. Sumkin JH, Berg WA, Carter GJ, et al. Diagnostic Performance of MRI, Molecular Breast Imaging, and Contrast-enhanced Mammography in Women with Newly Diagnosed Breast Cancer. Radiology. 293(3):531-540, 2019 12. Observational-Dx 99 women To compare extent-of-disease assessments by using MRI, CEM, and MBI versus pathology in women with breast cancer. A total of 102 women were enrolled and 99 completed the study protocol (mean age, 51 years ± 11 [standard deviation]; range, 32-77 years). Lumpectomy or mastectomy was performed in 71 women (79 index malignancies) without neoadjuvant chemotherapy and in 28 women (31 index malignancies) with neoadjuvant chemotherapy. Of the 110 index malignancies, MRI, CEM, and MBI depicted 102 (93%; 95% confidence interval [CI]: 86%, 97%), 100 (91%; 95% CI: 84%, 96%), and 101 (92%; 95% CI: 85%, 96%) malignancies, respectively. In patients without neoadjuvant chemotherapy, pathologic size of index malignancies was overestimated with all modalities (P = .02). MRI led to overestimation of 24% (17 of 72) of malignancies by more than 1.5 cm compared with 11% (eight of 70) with CEM and 15% (11 of 72) with MBI. MRI depicted more (P = .007) nonindex lesions, with sensitivity similar to that of CEM or MBI, resulting in lower positive predictive value of additional biopsies (13 of 46 [28%; 95% CI: 17%, 44%] for MRI; 14 of 27 [52%; 95% CI: 32%, 71%] for CEM; and 11 of 25 [44%; 95% CI: 24%, 65%] for MBI (overall P = .01). 3
88. Covington MF, Parent EE, Dibble EH, Rauch GM, Fowler AM. Advances and Future Directions in Molecular Breast Imaging. J Nucl Med 2022;63:17-21. Review/Other-Dx N/A To highlight the current state of the art and future directions in MBI. No results in abstract. 4
89. Colin C, Delov AG, Peyron-Faure N, Rabilloud M, Charlot M. Breast abscesses in lactating women: evidences for ultrasound-guided percutaneous drainage to avoid surgery. Emerg Radiol. 2019 Oct;26(5):507-514. Review/Other-Dx 92 patients To determine recovery with ultrasound guided (US-guided) procedures for treatment of lactational breast abscesses without surgical incision for drainage. The median diameter of abscesses was 4.5 cm (range 1-15), 82/105 (78%) were larger than 3 cm and 40/105 (38%) larger than 5 cm. US-guided management was successful for 101/105 (96%; 95% CI, (91-99%)) abscesses regardless the size. After the first round of procedures, 49/105 (47%) abscesses were recovered, 56/105 (53%) needed more than one drainage with a median number drainages of 2.6 (2-6). In 4/105 cases (4%), women underwent additional surgery under general anesthesia. By excluding abscesses which occurred in the weaning phase (n = 17), breastfeeding carried on for 68/75 (91%) women. 4
90. Ding ST, He XP, Ma XJ, Zhang Y, Liu XX, Qin J. Lactational Breast Abscesses Caused by Methicillin-Resistant or Methicillin-Sensitive Staphylococcus aureus Infection and Therapeutic Effect of Ultrasound-Guided Aspiration. Breastfeed Med. 2020 Jul;15(7):471-474. Review/Other-Dx 132 = MSSA infection 39 = MRSA infection To investigate whether (1) there are any differences in lactational breast abscesses between patients from whom methicillin-resistant Staphylococcus aureus (MRSA) and those from whom methicillin-sensitive S. aureus (MSSA) were isolated from pus samples and (2) there are differences in the effects of ultrasound-guided aspiration. There were no significant differences in abscess cavity location, abscess cavity amount, and abscess cavity size between both groups. The antibiotic utilization rate of the two groups were 58.3% (MSSA, 77/132) and 69.2% (MRSA, 27/39), respectively, and there were no significant differences between both groups. The cure rates of ultrasound-guided aspiration of the two groups were 97.7% (MSSA, 129/132) and 92.3% (MRSA, 36/39), and there were no significant differences between both groups. There were also no significant differences in the median number of aspiration performed for cure between the MRSA infection group (median = 3, range = 1-10) and the MSSA infection group (median = 3, range = 1-14). 4
91. Zhou F, Li Z, Liu L, et al. The effectiveness of needle aspiration versus traditional incision and drainage in the treatment of breast abscess: a meta-analysis. Ann Med. 2023 Dec;55(1):2224045. Meta-analysis 9 RCTs 703 patients To systematically compare the clinical effectiveness of NA and ID in treating breast abscesses. Nine RCTs were included, including 703 patients. The results showed there was no significant difference in cure rate between the two groups (relative risk [RR] = 0.96, 95% confidence interval [CI] [0.86, 1.07]; p = .469), and after subgroup analysis, we found that it was not related to the use of ultrasound guidance or not. There was no significant difference in the recurrence rate (RR = 0.68, 95% CI [0.35, 1.30]; p = .241). Furthermore, the NA group was associated with shorter healing time (weighted mean differences = -11.02, 95% CI [-15.14, -6.90]; p < .001), lower incidence of breast fistula (RR = 0.21, 95% CI [0.06, 0.72]; p = .013), lower interrupted breastfeeding rate (RR = 0.28, 95% CI [0.20, 0.39]; p < .001), and higher satisfaction rate of appearance (RR = 1.51, 95% CI [1.03-2.21]; p = .035). Good
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